What is a plantar callus?
Plantar callus is thickened layers of skin that arise at areas under constant friction and pressure. It forms as the body’s way of protecting the healthy skin that is under constant trauma. Individuals with reduced fat padding under their forefeet as well as retracted digits are more likely to suffer from frequent calluses on the feet. This pressure/friction can be due to foot structure, your walking/running style and also footwear. Plantar callus feels rough and hard skin, this skin can build up and become very thick. The size of these areas of plantar callus differ greatly from person to person and come in a variety of sizes both in terms of area covered and the distance extending out from the skin. Calluses on the feet have varying levels of pain, some are not painful whilst others are unable to put pressure on their feet or face constant feelings of discomfort.
What are the symptoms of a plantar callus?
Some of the symptoms include rough, hard, yellow areas of skin in a certain location on the foot. This can have varying degrees of pain for all individuals with most cases being discomfort whilst weight bearing. When the layers of callus are minimal these are often not painful but as they grow in size they can become painful. When plantar callus becomes excessive it can also make footwear more difficult to wear as it raises off the skin. Plantar callus can also result in people being unable to walk barefoot as there is no cushioning from footwear. Calluses on the heels that are left untreated can lead to cracking in the heels which then have a chance to become fissures. Fissures of the heel can be very painful and sometimes bleed. Similarly all foot callus poses the risk that if left untreated there is a possibility that the skin can break down and bleed. The other issue with a breakdown in plantar callus is that it leaves the body exposed and provides an opening for possible infections. At the very worst this breakdown can result in foot ulcers, this is more commonly seen in diabetics.
How plantar calluses differ from other skin growths
Plantar callus can often be confused or associated with corns and warts. This is due to them being associated with both, often you will find a corn or wart underneath or surrounded by a layer of callus. Corns are much smaller in size and normally are far more painful, often this pain can be created simply by applying pressure directly on top of the corn. Corns are also similar due to them consisting of dead skin. They have a centre point that arises due to a very specific and localised point of pressure/friction. They are treated similarly to callus and can be safely removed via the trained hand of a podiatrist. Warts can also be confused with plantar callus however they are quite different. Callus consists of dead skin but a wart is a virus within the body. Due to it being a virus this makes it much more stubborn and tough to treat. More aggressive treatment methods, such as salicylic acid, are needed for warts versus the simplicity of a scalpel blade for plantar callus. Your podiatrist will be able to differentiate between these other skin growths with a few simple tests. We are experts in dermatological care of the foot.
What causes plantar calluses?
Plantar calluses are formed as a result of excessive pressure and friction. There are a few factors that directly impact levels of pressure. Foot and bone structure can play a massive role in the development of callus on the foot. People with well defined bony prominences such as prominent metatarsal heads can often develop plantar callus due to a lack of skin between the bone and ground which leads to increased pressure within the area. Weight bearing for long periods of time typically develop calluses and may need offloading or shoe inserts in the long run. Hard callus forms over the top of these prominences due to the consistent force going through a particular area. Another factor for callus is the mechanism of gait, we all have a particular walking and running style. All individuals have different areas of plantar pressures whilst walking and running, if the pressure in the areas becomes too great then we see the formation of plantar callus. Footwear can also increase friction at sites. Ill fitting shoes where the shoe is too big and therefore too much movement occurs within the shoe can result in high areas of friction and the formation of plantar callus. Likewise shoes that are too tight on a particular area, such as a bunion within the toe box are also at risk of developing hard skin.
How is foot callus treated?
Calluses on the feet are most commonly treated through debridement via the use of a scalpel blade. Podiatrists are trained in using a precision blade to slowly shave down the calluses on the feet, layer by layer and relieve pain. We even provide medical pedicures! Calluses typically can be removed within the appointment provided time allows however some elect to leave a little bit on as removing too much can leave the skin raw. A sanding disk called a moore’s disc is then used to smooth over the debrided area and remove any minuscule amounts of plantar callus to get a nice finish. The moore’s disc can also be used in place of a scalpel blade if the callus is not a great amount or if the individual is too nervous to have a blade used. This however is not as effective as using a scalpel blade to remove plantar callus but can be beneficial to some degree. A regular nail file can also be used in place of a scalpel blade but you will see much less significant results however this is not a bad option for home management in between podiatry appointments. Can I use a callus remover that I bought from the chemist? It depends on the product you buy, pumice stones are safe and easy to use. Sharp options that are potentially dangerous and have the ability to self harm should be avoided. If you have any questions on a product that you intend to use for home care then it would be a good idea to bring this into your podiatrist so they can have a look. We can also look at offloading these high areas of pressure and friction. The use of felt padding or shoe inserts can be used in order to shift plantar pressures and therefore reduce the likelihood of plantar callus forming within the area. Footwear can also be assessed to ensure that it is adequate for your feet and not resulting in pressure or friction. By getting the correct offloading in place we can slow the growth rate of the callus or in some cases stop it completely.
What is the outlook for a plantar callus?
Plantar callus differs for all individuals in terms of growth speed and size. At the podiatry consultation the callus can be removed with ease and fixed on the spot but then you may ask what is the long term approach? We can attempt to offload the sites where plantar callus is forming through the use of orthotics and padding. If it stops the growth completely then there may not need a follow up appointment but if the callus re occurs then we will look to schedule frequent appointments. This varies in time due to callus affecting people differently, can be every couple of months or twice a year. Home care can also be very beneficial in keeping plantar callus at a minuscule level. Self care can be performed with a callus remover (such as a pumice stone) can delay the time needed for podiatry treatment as it can remove some of the layers of callus. Once again you should never attempt to use sharp tools such as scissors or nail clippers to remove your plantar callus.
Calluses in people with diabetes
Foot callus and diabetes are a potentially dangerous combination. When plantar callus is left untreated it can begin to breakdown and open up which results in foot ulcers. These ulcers pose a great risk as these can be tricky to heal and could become infected resulting in ulceration. Diabetes also adds another element due to the effects that poorly controlled blood sugar levels can have on both the blood supply and the nerves within the feet and legs. Poor diabetic management can lead to a reduced blood supply to the feet which can result in the body having a decreased chance to heal a potential skin tear or ulceration that can arise due to plantar callus breaking down. Another result of poorly controlled diabetes is a loss of protective sensation which means a reduced feeling under the foot. How does this impact plantar callus? If an individual is unable to feel an area of callus they will continue to leave it untreated and this can lead to a breakdown in the callus and potentially lead to an ulcer. It’s very important for diabetics to check their feet daily. Diabetics with callus should never look to remove it themselves as they are most likely to do more harm than good. It is very easy to harm yourself and it would not be performed in a sterile fashion which opens up the door to possible infections and self harm. At Foot Centre Group you may be able to see our podiatrists under Medicare.
When to see a doctor?
A podiatrist should always be your first contact when it relates to dealing with plantar callus as they are best equipped to remove the plantar callus safely. They will also offer advice on a long term plan as well as giving any important information. If unable to see a podiatrist then your main concern should be looking for signs of infection such as pain, redness, swelling and exudate. If you have any of those signs or high levels of pain or bleeding then see your doctor as soon as possible. A doctor should also be able to refer you to a podiatrist if you do not currently have one.